Care for the elderly

Older people often suffer from a multitude of illnesses that pose a challenge to organ-specific specialists. Geriatricians can help identify and prioritise their patients’ ailments.

STROKING her thighs as a senior physiotherapist straps on a pair of striking pink sand weights onto her ankles, Bong Fah Heong shows no signs of exhaustion as she prepares to repeat a series of physiotherapy exercises.

Once the sand-filled weights are firmly wrapped around Bong’s slim ankles, Universiti Malaya Medical Centre’s Lokman Abdul Majid helps her to work on strengthening exercises which include calf raises, knee extensions and standing knee flexions.

Lokman gives her a few words of encouragement and eventually, the 83-year-old grandmother of seven rises to the challenge and completes the low impact exercises without breaking a sweat at the gym housed in UMCC’s geriatrics division, in Petaling Jaya, Selangor.

“Although the exercises seem mah fun (inconvenient), I need to do them diligently in order to walk independently,” says the former machine operator who lives with her daughter – one of her eight children – in PJ.

The octogenarian is among 300 respondents of the Malaysian Falls Assessment And Intervention Trial (MyFAIT), a study conducted by the division to determine the common causes of falls in older adults and ascertain effective treatment options for this debilitating condition. Respondents are 65 years and above, who have been treated for fall injuries in the last 12 months at UMMC.

Cheering Bong on is the Associate Professor Dr Tan Maw Pin, the geriatrician conducting the research.

Based on historical data by Tinetti et al published over 20 years ago, 30% of people over the age of 65 fall at least once a year, says Dr Tan, 37. There’s a misconception that instability is a common problem among senior citizens.

“Older people are prone to falling due to factors such as instability, medication, poor eyesight, heart conditions and memory problems. We want to identify specific issues that are relevant to elderly Malaysians and work towards solving this problem,” she explains.

The division has also conducted clinical and laboratory studies on dementia, Frailty Among Inpatient Geriatric Medicine (FIG), and the Malaysian Elders Longitudinal Research (Melor, a long-term study on older people).

While it maybe relatively unknown to many, it plays a vital role in identifying and treating medical problems among elderly people. These include geriatric syndromes and conditions, prevention of various health issues such as instability, immobility, incontinence and intellectual impairment, and psycho-social and ethical issues.

Specific needs

UMMC’s geriatrics division, formed in 1998, has four arms – research, clinical services, administration and development, and teaching. Clinical services is sub-divided into three specialised areas – the general geriatric clinic (which caters to patients 65 years above), memory clinic (tackles memory-related issues such as dementia) and falls (handles patients at risk of falling).

Heading the division is Professor Dr Philip Poi, who works with a team of geriatricians: Associate Professor Dr Shahrul Bahyah Kamaruzzaman, Associate Professor Dr Chin Ai-Vyrn and Dr Tan, who specialise in specific areas such as frailty, memory and falls, in addition to handling general geriatrics.

“The elderly suffer a multitude of illnesses ranging from heart disease to stomach complications to arthritis. It is a challenge for organ specific specialists (such as cardiologists and gastroenterologists) to handle these complex issues in a holistic way. Geriatricians need to identify and prioritise issues at hand to enable senior citizens to live in a comfortable manner,” he says.

For example, falls can lead to fractures and other injuries, which can be prevented through early detection.

“Older people have age specific conditions that affect various body functions, which include memory, stability and continence,” adds Dr Chin. We also concentrate on iatrogenesis – complications that occur in patients due to medical treatment by a physician or surgeon.

“Often, we have patients who face side effects after taking medication for a problem. We need to rationalise the medicine to determine what’s needed. It is important to nip the problem in the bud before there is a cascading series of problems.”

On average, Dr Poi and his team consult over 200 outpatients monthly. Daily at the geriatric ward located on the 13th floor of UMMC, a team of dedicated nurses tend to about 30 patients hospitalised for various health problems. In a month, the ward can house over 100 patients.

It’s not wrong to say that their efforts have given a new lease of life to the elderly.

“Since the mid-1950s, life expectancy has increased and, on average, people are living into their 70s. This has resulted in a need to improve the quality of health care for the elderly,” explains Poi, who is part of The Star’s Health and Ageing Panel. Members of the panel have wide experience in medical health education for the public.

Besides tackling medical conditions, geriatricians also work closely with occupational therapists to look into emotional and social issues that impact the lives of their patients.

“Arthritis curbs one’s mobility and often results in social isolation. Sadly, some pedestrian walkways or public transportation aren’t conducive for the elderly and disabled. Part of our job is to identify obstacles and team up with occupational therapists to come up with ‘environment-friendly’ solutions,” he adds.

Growing demand

While better healthcare services has contributed to a longer lifespan, it has also resulted in a growing number of older patients in need of consultation and admission to hospitals.

One of the biggest challenges faced by the Health Ministry is the lack of geriatricians to meet the needs of seniors, who make up seven per cent of the country’s population of 28 million. Currently, there are only 16 such doctors in Malaysia – nine in Selangor and Wilayah Persekutuan, three in Perak, and one each in Penang, Malacca, Sabah and Sarawak.

In Services For Older People In Malaysia: Issues and Challenges, an academic paper co-authored by Dr Poi and published in the British Geriatrics Society’s Age And Ageing in 2004, he noted that geriatric medicine needs to be firmly embedded in undergraduate and postgraduate curricula (medicine, nursing and therapy).

This will enable Malaysia’s current and future generations of healthcare professionals to develop skills to access and manage the older patient, and recognise atypical presentations of common diseases in those aged 65 and above.

“Health Ministry director-general Datuk Seri Dr Hasan Abdul Rahman has tirelessly proposed this issue to all medical schools. The biggest challenge is these institutions don’t have geriatricians at hand to teach medical undergraduates,” explains Dr Poi, adding that there are currently six geriatric trainees in the country. They undergo attachments in various hospitals, including a nine- to 12-month clinical fellowship/attachment at UMMC.

Dr Chin says he did not have any reservations about joining this niche profession, which he finds exciting and challenging.

“The best part of the job is being able to care for the physical, emotional and social circumstance of elderly patients. Although it is a challenge to deal with many co-morbid diseases simultaneously, it is incredibly satisfying to help them get on their feet again.”

Dr Shahrul explains that it is important to educate schoolchildren on elderly care.

“Schoolchildren have a faint idea of what growing old is all about. There is a disregard for elders and a growing gap between the generations due to modern technology. It is important to bridge the gap by introducing more activities between young and old in the community. Education from a young age is key,” she adds.

UMMC Geriatrics Unit’s memory and geriatrics clinics are open on Thursday and Friday, respectively, from 2pm to 5pm. Patients need a referral letter to make an appointment. For details, call 03-7949 2334 (memory) or 7949 2388 (general geriatrics).